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<article class="col11"><p style="font-family:Verdana, Geneva, sans-serif; font-size:18px; margin:auto; padding:15px;">"##/##/####"<br /><br />##:##:##<br /><br />COUNTER:<br /><br />"Veronica Casas Azañedo"</p><img src="images/fuckencia.jpeg" width="200px" /><br /><br /><br /><img src="images/counter.png" width="200px" /><br /><br /><br /><img src="images/peru.png" width="200px"/><br /><br /><br /><img src="images/cargo.png" width="200px" /></article>
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                    <!----------------DATOS DE REMITENTE--------------------->
                    	<div style="float:left;font-size:15px;font-weight:800;color:#439DEB;text-decoration:underline;">Datos de Remitente</div>
                        <div style="margin-left:90px; padding-top:35px;">
                        	<div style="float:left;">Codigo de Remitente:</div></br>
                            
                        	<div style="float:left;">Tipo:   
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                                    	<option>-------</option>
                                        <option>Natural</option>
                                        <option>Juridico</option>
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                     <!-------------------DATOS DE REMITENTE NATURAL---------------->
                     <div style="float:left;font-size:15px;font-weight:800;margin-left:-310px;margin-top:30px;margin-bottom:10px;color:#439DEB;text-decoration:underline;">Datos de Remitente Natural</div>
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                        	<div style="margin-left:-250px" class="wrapper"><input type="text" class="input">Nombre:</div>
							<div style="margin-left:-250px" class="wrapper"><input type="text" class="input">Apellido:</div>	
                            
                        	<div style="margin-left:-125px;float:left;" class="wrapper">Documento de Identidad:   
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                                    	<option>-------</option>
                                        <option>Dni</option>
                                        <option>Passaporte</option>
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                         <!-------------------DATOS DE REMITENTE JURIDICO---------------->
                     <div style="float:left;font-size:15px;font-weight:800;margin-top:30px;margin-bottom:10px;color:#439DEB;text-decoration:underline;">Datos de Remitente Jur&iacute;dico</div>
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                            <div style="margin-left:-250px" class="wrapper"><input type="text" class="input">Apellido de Contacto:</div>
                            <div class="radio"><input type="radio" name="name1" checked>Masculino</div>
                            <div class="radio"><input type="radio" name="name1" checked>Femenino</div>
                            <div style="margin-left:-250px" class="wrapper"><input type="text" class="input">Cargo:</div>
                        	<div style="margin-left:-125px;float:left;" class="wrapper">Documento de Identidad:   
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                                    	<option>-------</option>
                                        <option>Dni</option>
                                        <option>Passaporte</option>
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                            <div style="margin-left:-250px" class="wrapper"><input type="text" class="input">Direcci&oacute;n:</div>
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                                    	<option>-------</option>
                                        <option>Dni</option>
                                        <option>Passaporte</option>
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                                    	<option>-------</option>
                                        <option>Dni</option>
                                        <option>Passaporte</option>
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                            <div style="margin-left:-250px" class="wrapper"><input type="text" class="input" value="dd/mm/aaaa"  onblur="if(this.value=='') this.value='04/11/2010'" onfocus="if(this.value =='04/11/2010' ) this.value=''">Fecha de Nacimiento (mm/dd/yyyy):</div>
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